CURRENT CONCEPTS IN ADULTS UPPER EXTREMITY FRACTURES

21452Ugur_TiftikciCurrent_Consept_in_adults.kapak

THE ROLE OF ARTHROPLASTY IN THE TREATMENT OF PROXIMAL HUMERAL FRACTURES

Eralp Erdoğan

Ankara Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Türkiye

Erdoğan E. The Role of Arthroplasty in the Treatment of Proximal Humeral Fractures. In: Tiftikçi U, Erdoğan E, Ergün C, Güneş Z, editors. Current Concepts in Adults Upper Extremity Fractures. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.51-61.

ABSTRACT

Proximal humerus fractures (PHF) account for 5-10% of fractures in adults and 26% in persons aged over 65. Women with osteoporosis encounter it more often. The treatment varies from conservative methods to various surgical procedures, depending on the patient’s age, comorbidities, and functional status.

When selecting appropriate surgical procedures for PHF, it is crucial to consider the patient’s age, comorbidities, functional expectations, fracture type, bone quality, and the surgeon’s expertise. The main goals of treatment are to relieve pain, maximize shoulder functionality, and improve the patient’s quality of life. We employ patient-centered treatment strategies by taking into account the individual characteristics of each patient and the particularities of the fracture’s morphology. There are many surgeries that can be done, such as open reduction and internal fixation (ORIF), intramedullary nailing, hemiarthroplasty, total shoulder arthroplasty, and reverse shoulder arthroplasty.

When osteosynthesis is not feasible or in the context of revision surgery, shoulder hemiarthroplasty serves as a surgical procedure to address proximal humerus fractures. The objective is to enhance the patient’s quality of life and rehabilitate joint function. During this surgery, which can be done with general or regional anesthesia, broken pieces are carefully removed, the humeral head is carefully cut out, and a prosthetic stem is put into the humeral canal. Accurate calibration of the prosthesis height and rotation is crucial for optimal functional outcomes. This surgical method is advantageous for the elderly and patients with moderate functional expectations, but it is less suitable for younger individuals and those with high functional activity goals. Shoulder hemiarthroplasty often has problems like infection, prosthesis loosening, periprosthetic fracture, rotator cuff insufficiency, glenoid wear, osteoarthritis, nerve damage, and stiffness in the joint.

Reverse shoulder arthroplasty is a specialized surgical procedure that replaces the concave glenoid surface with a convex prosthesis. This design enhances the forcearm of the deltoid muscle, thereby improving shoulder joint mobility and facilitating shoulder abduction, even when the rotator cuff muscles are limited or nonfunctional. Orthopedic and trauma surgeons often choose shoulder arthroplasty, especially for older people with complicated proximal humerus fractures and people who have degenerative joint disease and persistent rotator cuff tears. Reverse shoulder arthroplasty has shown positive long-term outcomes, including pain relief, improved shoulder mobility, and greater independence. However, reverse shoulder arthroplasty poses specific challenges, requiring precise surgical technique and careful patient selection.

Keywords: Proximal humerus fractures; Neer classification; Shoulder hemiarthroplasty; Revers shoulder arthroplasty; Total shoulder arthroplasty

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